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MANILA BAY DATA BASE SYSTEM

COMMERCIAL ESTABLISHMENT FORM 2022


WATERBODY
WATERBODY NAME : ____________________
WATERBODY TYPE : _____________________

ESTABLISHMENT INFORMATION
OWNER NAME : _____________________________________________________________________
(Last Name) (First Name) (Middle Name)

ESTABLISHMENT NAME : _________________________________________


ESTABLISHMENT STATUS :
( ) COMMERCIAL ( ) FACTORY
ESTABLISHMENT STATUS :
( ) OPERATIONAL ( ) SUSPENDED/ CLOSED
( ) NON – OPERATIONAL

NATURE OF BUSINESS : ____________________________


BUSINESS PERMIT :
( ) YES ( ) NO
Permit #: _______________
NO. OF EMPLOYEES : _______

ADDRESS INFORMATION
STREET/PUROK : __________________
BARANGAY : __________________
MUNICIPAL/CITY : __________________
PROVINCE : __________________
REGION : ___________________
COORDINATES : (lat)__________ (long) ____________

SANITATION
SEPTIC TANK :
( ) YES ( ) NO

SEPTIC TANK TYPE :


( ) HYGENIC ( ) NON-HYGIENIC

EASTMENT
( ) INSIDE ( ) OUTSIDE

REMARKS : ___________________________________________________________________
DATE GATHERED : _______________________

INTERVIEWER : _______________________________________
SIGNATURE OVER PRINTED NAME
Noted by:
SIMPLICIO T. PRINCIPE
Barangay Chairman

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